The Usefulness of Clinical Scoring System as Prognostic Predictor in Neonatal Seizure

ABSTRACT

PURPOSE: Neonatal seizure is usually the presentation of underlying neurologic dysfunction rather than a disease and have high mortality and morbidity as sequalae. Therefore, the parameter predicting the neurologic prognosis is necessary. This study was performed to identify the usefulness of clinical scoring as predictor in neonatal seizure by analyzing outcomes. METHODS: From 1982 to 1994, 101 neonates were admitted to Neonatal Intensive Care Unit(NICU) of Ewha Womans University Tong Dae Mun Hospital due to neonatal seizure and their medical records were reviewed. The follow-up data were reviewed in only 43(42.6%)patients. We scored five clinical manifestations including birth weight, etiology, type of seizure, duration of seizure and neurologic examinations at seizure and differentiated the follow-up data into favorable outcome(normal) and unfavorable outcome(neurologic abnormality, delayed development, frequent seizure, death, or hopeless discharge). RESULTS: 1) Clinical manifestation Most patients(81.2%) were full term. Seizure of most patients(88.1%) including all very low birth weight infants occured within seven day of age. The etiology of seizure were early hypocalcemia 29 cases(28.7%), severe hypoxia 26 cases(25.8%), electrolyte abnormality 13 cases(12.9%), septicemia 10 cases(9.9%), SAH or SDH 9 cases (8.9%) and hypoglycemia 9 cases(8.9%). The type of seizure were 61 cases(60.4%) of tonic type, 24 cases(23.8%) clonic type, 15 cases(14.8%) of subtle seizure, and 1 case of myoclonic seizure who had holoprosencephaly. The duration of seizure were 49 cases(48.5%) of repetitive brief, 34 cases(33.7 %) of more than 60 sec and 18 cases of single brief. The neulologic findings at seizure showed that 47 cases(46.5%) were normal, that 40 cases(39.6%) were markedly abnorml and that 10 cases(9.9%) were mildly abnormal. 2) The validity of clinical scoring to unfavorable outcome showed 90.9% of sensitivity, 47.6% of specificity, 64.5 of positive predictive value, and 83.3 of negative predictive value when the cut-off point of scores was 4. 3) The birth weight, the duration of seizure and neurologic findings at seizure were good parameters predicting unfavorable outcome (p< 0.05). CONCLUSIONS: The clinical scoring had high sensitivity and high negative predictive value as prognostic predictor. Especially, the birth weight, the duration of seizure, and neurologic finding at seizure were useful items.